Monsters of Imagination

I entered the conference room nervously.  Not tentatively, but that other kind of nervous where I charge right in, sit down next to the invited speaker, talk too fast and laugh too much.  I hadn't intended to attend this group's meeting so soon -- or ever.  "Friends of children with special needs" somehow didn't evoke friendliness for a girl like me, only fear of judgment and rejection.  But they were hosting this special meeting: How to Talk to Children About Traumatic Events.  I couldn't exactly miss that one.

The meeting had been scheduled in response to the horrific mass murder of school children and teachers in Connecticut.  I listened to the speaker's introduction, picking nervously at a bagel.  "I know it feels as though you'll be shattering their world to talk to them about traumatic events and death, but they absorb far more than you realize.  Even the youngest child is capable of imagining much, much worse than even this terrible reality.  Avoiding the topic altogether isn't doing your child any favors."

***

I have noticed that this is how it is for our culture's understanding of late-term abortion.  When I walked onto the plane, headed for a clinic hundreds of miles away, I fully expected to come back infertile, or not to come back at all.  It felt exceedingly risky and terrifying.  Laurel's wriggles and kicks were as agonizing as they were precious in those moments.  I couldn't bear to think what was coming for either of us.

That's why they spend about eight hours with you on your first day, thoroughly explaining the procedure, the risks, and what to expect for both your own outcome and the outcome of your baby.  Eight hours of testing and counsel, capped off with either signing the document and walking into a procedure room, or standing up and walking away.

I'm going to explain it here, in general terms.  It's hard to stomach, no doubt, but not gory the way you're probably imagining.  Skip the next section if it's too sad or graphic.

***

It all starts with an injection.  That's what is waiting in the procedure room.  Just like an amniocentesis, a needle guided by outdated ultrasound, only instead of avoiding the baby and sampling the fluid, the needle entered Laurel, too, and found her heart.  My angel of a nurse had warned me that this would be the hardest part, and she was absolutely right.  It was absolutely the hardest thing I've ever done.

And yet, it's also not as bad as those monsters of my imagination.  It's not violent or abrupt.  It's just a shot.  I think of how many shots Elsie got in her first months as a healthy infant, with fully-functioning brain, and how she didn't even cry for any of them.  Maybe infants' nerves aren't quite hooked up yet, or maybe shots just don't hurt as much without the anticipation.  Laurel seemed to take after her sister this way.  She was calm.  The drug slows the heart over a few hours until it, and the beloved baby, rest still.  She died in the only place she was destined to be comfortable and compatible with life: my womb.  The rest is safely managing a stillbirth.

Day 2 and Day 3 are cervical dilation days.  Laminaria (sterile seaweed sticks -- really) are inserted into the cervix, as many as fit, then changed for more.  Then I was stuffed up like a turkey, full of cotton gauze soaked in iodine.  It hurts about as much as you'd imagine, and you are supposed to lie still and calm for the insertion.  Yeah right.  These appointments are quick.  The rest of the day, open.

On the plus side, the laminaria did the first 4 cm or so of dilation for me.  That'd be approximately the first 19 hours of Elsie's labor.  It's a crampy couple of days with those seaweed sticks, but it beats 19 hours of labor.

Day 4 is labor induction: IV, break the waters, get the drugs, labor, deliver the baby.  I've written about this labor, about how important it was for me.  If I couldn't heal her, then by gum, at least I would deliver her.  It was something to do when there was absolutely nothing else to be done.

She came quickly, easily, and in one piece, with forceps on the shoulders more as a matter of caution than necessity.  I cried and thanked the doctor for saving my life, and Laurel's, and Hub's, and Elsie's.  He was all concentration.  I thanked him with all of my heart as he did a quick vacuum evacuation of the uterus to avoid the scary bleeding of Elsie's birth.  It didn't hurt too much.  Not the way it had after Elsie.

***

There are other procedures for abortion, but this was the only one I was offered -- my doctor developed it over the course of a four-decade career in late-term abortion, developed it to minimize morbidity and mortality on the mother.  Though the doctor was different, I assume that it was the exact same procedure that a 29-year-old teacher underwent at a Maryland clinic last week.  She was in her third trimester, too, with a baby she loved and wanted, but who was sick.

But that mom died.  She died saving her baby, complications of the procedure.

That I even know this is a travesty and a shame.  Not a shame like "aw, shucks, what a shame."  A shame like something we all should be deeply ashamed of.  Ask yourself why this is a news item?  Her family didn't go to the reporters.  Why, then do we know about this woman's name and her face and how many weeks pregnant she was?  Why do we know that she wasn't from MD, but was staying in a hotel for the week of her procedure?  So much for her legal right to privacy.  Somebody leaked her records.  Protesters must have stalked her to her hotel to give up details to the reporters.  It's sick that she wasn't better protected in a time of sadness and family crisis, and sicker still that she wasn't even protected in death.  A shame on all of us.

***

I wanted to write about this today, not because I owe anyone an explanation of what I went through -- I don't.  It's deeply personal, and deeply private.  But because I know that what you imagine happened in that clinic is probably worse than what actually happened (as sad and serious as the reality is).  It is so easy to create a sensation of lies and simplistic, emotional drivel.  Maybe knowing more helps.

Poor Dr. Carhart -- a man who has devoted his life to the cause of keeping women like me and women like her safe from the huge risks of illegal, secret, back-alley abortion.  That's why they do it, you know.  Because they care about women.  Nobody but the woman's family and dear friends cares more than he does.  He will be raked over the coals, and one clinic out of only a few in the country that offers 3rd trimester abortions will, perhaps, close.  If this happens, it will only increase the risk for women.

Illegal abortion, pre Roe v. Wade, was quite risky.  A leading cause of death among women of fertile age.  Legalization and the subsequent practice and improvement has led to much better odds.  Third trimester is riskier than second, which is riskier than first-trimester abortion.  All of these, however, are less risky than live birth.

By the early 1990s, the risk of death in early abortion was fewer than 1 death per 1 million procedures, and for later abortion, about 1 death per 100,000 procedures (Koonin et al. 1992). The overall risk of death in abortion was about 0.4 per 100,000 procedures, compared with a maternal mortality rate (exclusive of abortion) of about 9.1 deaths per 100,000 live births (Koonin et al. 1991a, 1991b) 

Encyclopedia of Marriage and the Family, Volume I

David Levinson, Editor in Chief. Simon & Schuster MacMillan, 1995

 Third-trimester abortion is less risky than live birth.  Approximately one order of magnitude less likely to kill a mother than "regular" birth.

Perhaps my terror stepping onto that flight was out of proportion to the risk I was taking.

And yet, as any mother of a child with a rare brain malformation knows, that lightning has got to strike somebody.

I am devastated for the woman it struck last week, her family, her clinic, and her community.  I don't know what else to say about it.